Predictive value of cystatin C-based estimated glomerular filtration rate combined with thromboelastogram for clinical prognosis of acute-on-chronic liver failure

Abstract

Objective To investigate the value of cystatin C-based estimated glomerular filtration rate （eGFR-CysC） combined with thromboelastogram （TEG） to predict clinical prognosis of patients with acute-on-chronic liver failure （ACLF）. Methods 34 patients with ACLF （ACLF group）， 26 patients with chronic hepatitis （chronic hepatitis group） and 30 patients with cirrhosis （cirrhosis group） were selected. Laboratory parameters within 24 h after admission， TEG parameters and eGFR-CysC value were collected and compared among three groups. All patients were divided into different groups according to the incidence of complications and prognosis. The risk factors affecting clinical prognosis of ACLF patients were analyzed by binary logistic regression analysis. The predictive value of these risk factors for clinical prognosis of ACLF patients was assessed by the receiver operating characteristic （ROC）curve. Results There were significant differences in the white blood cell count （WBC）， alanine aminotransferase （ALT）， total bilirubin （TBIL）， albumin （ALB）， C-reactive protein （CRP）， prothrombin time activity （PTA）， prothrombin time （PT）， international normalized ratio （INR）， reaction time of TEG （R）， maximum amplitude （MA） and eGFR-CysC among different groups （all P < 0.05）. ACLF intra-group analysis showed that MA and eGFR-CysC were significantly different between patients with or without acute renal injury （both P < 0.05）， R and MA were significantly different between patients with or without upper gastrointestinal bleeding （both P < 0.05）， MA and eGFR-CysC significantly differed between the death and survival groups （both P < 0.05）. Binary logistic regression analysis suggested that MA （OR=0.439， 95%CI 0.231-0.833， P = 0.012） and eGFR-CysC （OR=0.931， 95%CI 0.878-0.988， P = 0.018） were the risk factors affecting short-term prognosis of ACLF. MA combined with eGFR-CysC yielded similar prognostic value in patients with ACLF （AUC=0.933， 95%CI 0.792-0.990） compared with Model for End-Stage Liver Disease （MELD） （AUC=0.839， 95%CI 0.672-0.942） （P > 0.05）. Conclusion MA and eGFR-CysC can predict clinical prognosis of ACLF patients. MA combined with eGFR-CysC yield similar predictive value for ACLF compared with MELD.

Keywords

• |acute-on-chronic liver failure|cystatin c-based estimated glomerular filtration rate|thromboelastogram|meld|prognosis